Help determining cause of arousals

Hi everyone. I'm posting because I'm looking for someone to look at my flow rate/leak data and maybe help me figure out what's going on. I've seen a lot of people recommend this forum so if anyone is able to help I'd really appreciate it.

Just as some background I was diagnosed with mild OSA (AHI 13.6 RDI 29.5) a little over a month ago via Lofta's home sleep test and have been on CPAP for about a month. Last week I switched to BiLevel as I found an amazing deal for an AirCurve 10 and figured why not try it out. The first 3 nights seemed to go pretty well despite struggling with leaks. It very well could've been placebo but it seemed to help quite a bit. Unfortunately, I had to send it back for a replacement just a few days later because something was wrong with the motor, but I still have my AirSense 10 to use for now until the replacement arrives. The past few days I've been using 12 cmH2O with EPR on 3, and was mainly using 11/7 when I still had my AirCurve 10.

I'll post some graphs from the other night below. Unfortunately I don't have access to my PC right now for OSCAR so mobile SleepHQ will have to do lol. I'm mainly curious about the arousals I'm seeing and their relationship to leak spikes/drops. It's difficult to tell if the change in leaks are causing the arousals or vice versa, and if arousals are causing the leaks, are they natural or something I should be concerned about? Often multiple will happen back to back (4-5 or so over the course of an hour) with no apparent decrease in airflow prior to the arousal. A lot of the time they're followed by erratic breathing for a period of time. I'm aware some amount of arousals during sleep is normal, but this just doesn't seem normal to me.

Anyways, I also have a pulse oximeter so maybe that will be of use in figuring out what's happening. Thanks to anyone who took the time to read. I'm open to any advice.

Rather than posting screen shots of the data at SleepHQ, post the "sharable link". That way we can zoom in on the data and try to correlate the leak data to possible evidence of arousals in the flow rate data.

But figuring out when and why an arousal occurred is an imprecise art rather than a science, and not all arousals have an obvious cause.

Having said that, I'll add: At this level of zooming out, there is evidence of multiple arousals---the large spikes in the flow rate graph. And there's obviously a lot of activity in the leak graph, and much of that activity seems to be in or close to official Large Leak territory (24 L/min) for the AirSense 10.

You do include two zoomed-in fragment of datas. I've downloaded them so I could mark them up with what I see that is relevant.

Here's a marked up version of the first zoomed-in snippet:

In this case, you aroused during a period of a steady leak. (Eyeballing it, it looks like this leak was around 5 L/min; small enough to not be a problem in terms of efficacy of therapy.) Once you aroused, you did some moving around and that made the leak worse. But it looks like fixed the leak and started working on getting back to sleep. However, by the time you may have gotten back to sleep (at the very end of this snippet), another leak started up. Eyeballing this new leak, it agains appears to be at around 5 L/min.

Now some people can easily sleep through a 5 L/min leak without any problems. Other people will wake up to even small leaks. And for some people it may depend on where the leak occurs. Did the first small 5 L/min leak wake you up? Well, that's hard to say from this snippet because we don't know how long that 5 L/min leak went on before the arousal happened. What I am confident in saying is that the larger leak (inside my red box) is not what woke you up: That leak occurred after the initial arousal and was likely caused by movement associated with the arousal.

Here's marked up version of the second zoomed-in snippet:

Again, I've labeled my interpretation of when you were most likely asleep, when the arousal occurred, and here, when there is some evidence of the transition back to sleep.

There is a base line leak that has been present for some time before the arousal, although we can't tell how long it's been going on from this snippet. Unlike the first snippet, however, the base line leak here appears to be close to the Resmed definition of a "Large Leak"---i.e. you were leaking at a rate of about 24 L/min before you woke up here. Again, we can't tell if that largish leak is the cause of the arousal because we don't know how long it had been going on before the arousal. Unlike in the first snippet, you must have fiddled some with the mask, in an attempt to fix the leak. It looks like you came kind of close to figuring it out since the leak rate temporarily drops close to 0, but you didn't really figure it out because the leak almost immediately goes back up to around 24 L/min as you start to transition back to real sleep. Clearly, you did fall asleep by the end of this snippet in spite of the leak. Now we can't say whether you got back to a sound sleep that lasted for quite a while or whether you woke back up (possibly because of the leak) in 5 or 10 minutes after this snippet ends. But there is evidence that your body was quite capable of ignoring that large base line leak long enough to get back to sleep at least temporarily.

I appreciate the response. I didn't think about sharing the link. I'll paste it below in case you're still interested in taking a look.

In hindsight this probably wasn't the best night to share considering there's at least some level of baseline leak throughout the entire night. That's pretty much every night though so I don't really have a control to compare these arousals against to see if they occur at the same rate without the baseline leak. What you said was definitely helpful, though. It does seem unlikely that the leak spikes themselves are causing the arousals. I suppose the only thing to do at this point is try to eliminate the baseline leak entirely and see if they still happen. I have a chinstrap coming soon so hopefully I'll be able to resolve that.

https://sleephq.com/public/fd5973fa-696 ... 913cd7dbb7

coutherino wrote: ↑

Tue Aug 20, 2024 6:16 pm

I appreciate the response. I didn't think about sharing the link. I'll paste it below in case you're still interested in taking a look.

I am getting ready to fly across country for a family funeral so I won't have time to scroll through your data until I get back from the funeral.

In hindsight this probably wasn't the best night to share considering there's at least some level of baseline leak throughout the entire night.

If you often have a baseline leak all night long, particularly one that is starting to flirt with official large leak territory, then I think we can safely say you need to do some work troubleshooting the leaks. They may be at least partially responsible for causing you to sleep lightly enough to easily arouse.

I suppose the only thing to do at this point is try to eliminate the baseline leak entirely and see if they still happen. I have a chinstrap coming soon so hopefully I'll be able to resolve that.

Yes, I do think you need to work on the baseline leak. The real question is whether you are actually leaking out of your mouth or whether the mask is springing a leak somewhere else.

Do you wake up with a dry mouth? Do you ever wake up with the sensation of air blowing out of your mouth?

On the other hand, do you ever wake up with air blowing in your eyes? Or on your cheeks or chin?

And, as silly as it sounds: Have you inspected both your hose and your mask for any small pinholes or small tears? Those things can often trigger a constant baseline leak that persists all night regardless of what you try to do to get a better seal on the mask.

I am getting ready to fly across country for a family funeral so I won't have time to scroll through your data until I get back from the funeral.

No worries. It's fine if you don't. I think I'm on the right track. Had a pretty leak free night last night and definitely slept a lot better.

Yes, I do think you need to work on the baseline leak. The real question is whether you are actually leaking out of your mouth or whether the mask is springing a leak somewhere else.

Do you wake up with a dry mouth? Do you ever wake up with the sensation of air blowing out of your mouth?

On the other hand, do you ever wake up with air blowing in your eyes? Or on your cheeks or chin?

And, as silly as it sounds: Have you inspected both your hose and your mask for any small pinholes or small tears? Those things can often trigger a constant baseline leak that persists all night regardless of what you try to do to get a better seal on the mask.

I'm quite certain the leak is being caused by jaw drop, as it's definitely coming from the bottom of the mask. I have woken up before with the sensation of air blowing on my chin. Plus when looking at my leak data I can see the leak slowly increasing as I drift off to sleep, further hinting at jaw drop. Typically before I fall asleep it does start off at 0 before rising to some amount of baseline leak, so I think I must've just not adjusted my mask correctly on the night I shared where there's one even before I fell asleep. So I doubt I have any issues with my mask or hose.

I'm also using a FFM so mouth leak isn't really a factor. Been there and done that with my nasal mask. I love it but I just couldn't eliminate the mouth leak no matter how much I taped and it was pretty detrimental to my sleep. Definitely experienced dry mouth with that, but haven't yet with the FFM.